Another way that outcomes can be grouped is by type: care-related,
patient-related, and performance-related outcomes (Kleinpell, 2009). An
example of a care-related outcome is the rate of pressure ulcer formation in
patients on bed rest for more than 24 hours. Patient knowledge related to fluid
restriction is an example of a patient-related outcome. Nursing staff adherence
to best practice guidelines when providing discharge education to a heart failure
patient is an example of a performance-related outcome.
Time is another way of classifying outcomes. Short-term outcomes are results
achieved in a relatively brief period of time that usually involve a change in
condition, such as absence of postoperative pain, or an increase in knowledge or
skills, such as a patient’s ability to draw up insulin. Another category of outcome
classified by time is intermediate outcomes. They exist when changes occur
after an innovation is introduced. Lifestyle modifications, such as weight loss
and smoking cessation after enrolling in a wellness program, can be examples
of intermediate outcomes. Long-term outcomes are primary changes in patients’
behaviors or status, such as compliance with statin therapy resulting in a lower
cholesterol level (Mauskop & Borden, 2011).
Nursing administrators are responsible for reporting nursing-sensitive
outcomes at their institutions to demonstrate effectiveness of nursing care.
Outcomes of nursing care should be measurable. These measurements can
assist in determining responsibility in patient care (Micik et al., 2013). One
nursing-sensitive outcome considered a National Patient Safety Goal mandated
by the Joint Commission is to reduce the risk of healthcare-associated infec-
tions with central line bloodstream infections (Joint Commission, 2017b). The
Joint Commission requires healthcare organizations to have education and
evidence-based policies/protocols relative to central lines. Hospitals are also
required to provide their central line infection rate to key participants. Two
desirable outcomes that result from these practices are an improved communi-
cation among all involved healthcare providers regarding central lines and an
associated reduction in hospital-acquired central line bloodstream infections.
Outcome-based measurements are a means used to establish evidence-based
practice (EBP) and to evaluate the care delivered. In healthcare organizations,
many activities are outcome driven. The rising costs of health care, increasingly
stringent accreditation standards, and public reporting are several reasons why
outcomes are closely scrutinized and are integral to ensuring the successful
implementation of an innovation. In health care, outcomes are typically quanti-
tative, not qualitative. Legislated in 2010, the Patient Protection and Affordable
Care Act has improvement in healthcare quality among its goals. Within this
legislation is a mandate regarding the development of a shared-savings program
promoting accountability to a patient population (Patient Protection and Af-
fordable Care Act, 2010). Termed Accountable Care Organizations (ACOs),KEY TERMS
outcome:
Consequence or
visible result
nursing outcomes:
Measures of
states, behaviors,
or perceptions of
individuals, families,
or communities
as they relate to
nursing and health
outcomes research:
Studies about the
effects of care and
treatments on
individuals and
populations
care-related
outcomes: A
category of
outcomes that
measures the
effect of nursing
interventions
patient-related
outcomes: A type of
outcome related to
patient behaviors or
actions
performance-
related outcomes:
A type of outcome
related to how
nurses perform
their job
short-term
outcomes: Results
achieved in a brief
period of time
intermediate
outcomes: Changes
that occur after
an innovation is
introduced472 CHAPTER 18 Evaluating Outcomes of Innovations